ASSESSMENT OF BURNOUT, SLEEP QUALITY, AND RESPIRATORY HEALTH AMONG FRONTLINE NURSING AND RESPIRATORY CARE STAFF IN ACUTE CARE SETTINGS: A CROSS-SECTIONAL STUDY IN SAUDI MILITARY HOSPITALS

Abstract

Background: Frontline healthcare workers in acute care settings face compounding occupational stressors that may simultaneously impair psychological wellbeing, sleep architecture, and respiratory health. Military hospitals in Saudi Arabia operate under distinctive organizational and operational conditions, including hierarchical command structures, high patient acuity, and fluctuating surge-capacity demands, yet remain substantially understudied in the occupational health literature.

Objective: To assess the prevalence and severity of burnout, sleep impairment, and self-reported respiratory health outcomes among frontline nursing and respiratory care staff across three Saudi military hospitals, and to identify independent predictors of high burnout.

Methods: A multi-site cross-sectional survey was conducted from September to December 2024 at Prince Sultan Military Medical City (PSMMC), King Abdulaziz Military Hospital (KAMH), and Armed Forces Hospital-Southern Region (AFH-SR). Stratified random sampling yielded a final analytic sample of 452 participants (267 nurses, 185 respiratory therapists; response rate 83.7%). Burnout was assessed using the Maslach Burnout Inventory–Human Services Survey (MBI-HSS); sleep quality using the Pittsburgh Sleep Quality Index (PSQI); and respiratory health using a validated self-report respiratory symptom questionnaire and occupational exposure inventory. Multivariable binary logistic regression was employed to identify independent predictors of high burnout (MBI Emotional Exhaustion score ≥ 27).

Results: High burnout was observed in 53% of nurses and 43% of respiratory therapists. Poor sleep quality (PSQI > 5) was prevalent in 85.8% of nurses and 80.5% of respiratory therapists, with mean global PSQI scores of 10.22 (±3.4) and 8.97 (±3.8), respectively. Respiratory symptoms were reported by 51.3% of nurses and 43.8% of respiratory therapists. In multivariable analysis, poor sleep quality (OR = 3.42; 95% CI: 2.11–5.54), lack of institutional support (OR = 3.08; 95% CI: 1.97–4.81), night/rotating shift work (OR = 2.87; 95% CI: 1.74–4.73), and perceived PPE inadequacy (OR = 2.21; 95% CI: 1.38–3.54) were the strongest independent predictors of high burnout. Burnout composite scores were positively and significantly correlated with PSQI global scores (r = 0.67, p < 0.001) and respiratory symptom burden (r = 0.48, p < 0.001).

Conclusion: Burnout, poor sleep, and respiratory health impairment co-occur at high rates among frontline nursing and respiratory care staff in Saudi military hospitals and are significantly interconnected. These findings underscore the urgent need for integrated occupational health programs that simultaneously address psychological, sleep-related, and respiratory health risks in this population.